Acute torticollis

Many people have experienced waking up with their head tilted to one side and feeling a pulling pain along the side of the neck and top of the shoulder when trying to turn the other way. This condition is called acute torticollis. "Torticollis" literally describes a neck tilted at an angle. In Korean, it is also called "giunmok," meaning "tilted neck," or by the older term "nakchim," meaning "a neck that has fallen off the pillow."

This article covers muscular torticollis that appears suddenly in otherwise healthy adults and then passes. It is distinct from congenital torticollis, which appears in infancy, and torticollis due to other causes.

The muscles on one side of the neck suddenly tighten firmly, pulling the head toward that side. Commonly discussed contributing factors include the following.

• Neck position during sleep — If your pillow is too high or too low, or if you sleep on your stomach with your head turned to one side for a long time, the muscles on one side of your neck remain stretched or compressed. This is why Sleeping position and Pillows and cervical alignment are relevant.
• Acute neck muscle tension — The Sternocleidomastoid, which runs from behind the ear down to the collarbone, or the Levator scapulae, which runs from the side of the neck to the upper part of the shoulder blade, suddenly tightens and restricts movement.
• Staying in one position for a long time — It can also occur after looking at a screen with your head turned to one side or exposing your neck to cold air for a long time.

This overlaps considerably with what people commonly describe in Korean as having a sudden muscle "knot" or "crick." You can read more about this phenomenon in Acute muscle stiffness, and localized tightness in the neck and shoulders is sometimes described in terms of Myofascial pain syndrome.

The first day or two are the most uncomfortable. Even turning your head or coughing can cause a pulling sensation in your neck, and it may be difficult to check to the side while driving. After that, the range through which you can turn your head gradually increases, and in many cases you feel more comfortable within a few days. This varies from person to person, and some people have lingering stiffness and aching for more than a week.

• Apply warmth. Warming your neck and shoulders with a warm towel or shower water helps the tightened muscles feel more comfortable. See also Heat and cold therapy.
• Move slowly within a pain-free range. Rather than forcing your head to turn toward the painful side, move it gently from side to side within a comfortable range to help reduce muscle stiffening.
• Avoid staying in one position for too long. When looking at a screen, adjust your Monitor height and viewing distance, and take breaks to loosen your shoulders by rolling them up and down.
• Choose a comfortable height for your neck during sleep. Try choosing a pillow that does not bend your neck out of alignment when you lie down.
• Do not bend your neck sharply or twist it forcefully. Trying to loosen it quickly by turning your neck to make it crack can instead cause the muscles to react by tightening further.

In most cases, this discomfort passes naturally. However, if any of the following unusual signs occur alongside it, there may be a need to look beyond the neck itself.

• Your neck becomes tilted immediately after a fall or impact
• You have a fever, or your neck is so stiff that you cannot bend it forward
• You have numbness or tingling and weakness in your arm or hand
• Symptoms do not improve after more than a week, or are getting progressively worse